1. Analytical summary

A massive active queue, very male and marked by precariousness

In 2024, 253 CSAPA out of 497 provided usable data (participation rate 51 %), amounting to 190,066 records, including 90,723 first-time consultants (p. 2, 19). The total annual active caseload is estimated at 332,600 people (p. 3). The public is 75 % male, with an average age of 41.2 years, predominantly low-educated (57 % below high school) and, to a notable extent, in social difficulty: 13 % in temporary housing, 2.5 % homeless (p. 3). Alcohol remains by far the primary reason (49 %), ahead of cannabis (18 %), heroin (9.4 %) and tobacco (5.8 %); referrals remain very predominantly spontaneous (48 %), with general practitioners addressing only 7.3 % of patients (p. 3).

Profiles that are recomposed product by product

The report details nine groups and compares, at constant scope, the first-time consultants of 2019 and 2024 (p. 9-17). The new patients in 2024 are slightly more educated and better integrated than in 2019 (employment 54 % versus 48 %; unemployment 11 % versus 21 %) (p. 9). The cases for cocaine (4.8 %), crack/cocaine-based (2.1 %) and other illicit substances are increasing, while cannabis and heroin are declining (p. 9). Injection continues to decline — 74 % of new heroin users have never used it, compared to 70 % in 2019 (trend confirmed at the European level, EUDA 2025) (p. 12-13). At the social extremes, the crack and TAO groups accumulate indicators of precariousness, while the alcohol, cocaine and non-substance addiction groups are significantly better integrated (p. 6-8, annex 1).

2. Key points of the document

1️⃣ Alcohol, the primary structural reason — but a distinct public. Nearly one in two patients (49 %) consults for alcohol; it is the group that is the oldest (45.6 years) and the most integrated (59 % in employment), contrary to the image of a marginalised public (p. 4, annex 1).

2️⃣ Cannabis, a young and heavily judicialised public. The youngest group (29.7 years) and the most male (83 %), it is distinguished by a judicial orientation for nearly a third (obligation of care 26 % + other measure 11 %) and a low spontaneous approach (32 %) (p. 5).

3️⃣ Crack and TAO, markers of great precariousness. The crack group accumulates 65 % with a level below the baccalaureate, 39 % in employment, 24 % in temporary housing and 6.9 % without a fixed address; the TAO group reaches 8.6 % of homelessness (p. 6-7, annex 1). These are the publics of outreach.

4️⃣ Cocaine and stimulant polyconsumption. The cocaine group is younger (36.8 years) and more integrated (nearly 60 % in employment); it is also the one that reports the most MDMA (4.2 %), amphetamines (2.1 %) and ketamine (2.0 %) (p. 6, annex 2).

5️⃣ Decline of injection, new forms of consumption. Injection is declining (heroin: 18 % of new users; cocaine: 8.5 % compared to 14 % in 2019) (p. 13-14). Regarding cannabis, the edible form rises from 1.4 % to 13 % of new users, linked to the spread of delta-9-THC candies according to Cherki & Feng 2026 (p. 12).

3. Action points for local actors

1️⃣ Position its active file. Compare the distribution by product and the social indicators of its structure to the averages in annex 1 to objectify its specific territorial characteristics in an activity report or a funding request (annex 1).

2️⃣ Target the outreach on crack and TAO. The homelessness rates (6.9% crack, 8.6% TAO) justify outreach, early consultations in emergency accommodation and partnerships with the AHI sector; rely on practice guides (see ref. Addictions France) (p. 6-7).

3️⃣ Anticipate the new forms of consumption. Integrate the cannabis edibles (delta-9-THC gummies) and the stimulant polyconsumption (cocaine + MDMA/ketamine) into the interviews and RdRD tools (p. 12, annex 2).

4️⃣ Strengthen the link with general practice. Only 7.3% of patients are referred by a general practitioner: raising awareness among local general practitioners and formalising referral pathways can broaden early access (p. 3).

5️⃣ Adapt the reception to the ageing of alcohol and heroin users. The high average ages (45.6 years alcohol; 43.6 years heroin) call for attention to comorbidities and loss of autonomy; coordinate with the health and social care for the elderly (p. 4-5).

6️⃣ Document the unmet needs. The decline in participation (51%) and the 20% of forms without product indicate blind spots: advocate for data collection methods and for access to care in rural areas, where the urban placement of CSAPAs creates inequalities (Feng 2025; Gérome 2025) (p. 3, 19).

4. Additional references

Internal resources — Health Practices 

• Thematic section "Addictions" — https://pratiquesensante.odoo.com/4-5-les-addictions

External resources 

• Addictions France Association (2026), Reference Guide – Pathways of individuals supported in CSAPA — https://addictions-france.org/datafolder/uploads/2026/04/GUIDE_reperesCSAPA-VDEF-2026.pdf

• Court of Auditors (March 2025), Young people's addictions to illicit drugs and alcohol (Annual Public Report 2025) — https://www.ccomptes.fr/sites/default/files/2025-03/20250319-RPA-2025-addictions-des-jeunes-aux-drogues-illicites-et-alcool.pdf

• Feng C. / OFDT (Dec. 2025), Treatments with opioid agonists in France – Assessment 2025 — https://www.ofdt.fr/publication/2025/traitements-par-agonistes-opioides-en-france-bilan-2025-2643

5. Frequently asked questions (FAQ)

1️⃣ How many patients are affected, and how is the figure obtained? 190 066 records used from 253 CSAPA; the total active caseload (332,600) is an estimate reported to the 2022 activity reports, not a direct count for 2024 (p. 3, 19).

2️⃣ Is alcohol still the primary reason? Yes, 49% of the active caseload, stable over time; it is also the dominant reason in the prison environment (45%) (p. 2-3).

3️⃣ Which populations are the most vulnerable? The crack/cocaine and TAO groups: homelessness at 6.9% and 8.6%, high inactivity, low education level (p. 6-7, annex 1).

4️⃣ What changes between 2019 and 2024? New patients are more educated and integrated; increase in cocaine / crack / and other illicit drugs; decrease in cannabis / heroin; decline in injection (p. 9).

5️⃣ Is injection really declining? Yes : 74 % of new heroin users have never injected (70 % in 2019); injection concerns only 18 % of them — a trend confirmed at the European level (EUDA 2025) (p. 12-13).

6️⃣ What are the ‘non-substance addictions’? Gambling and games of chance (now the main reason for the group, 37 % of new users), cyber addiction (28 %) and eating disorders; a younger, more female, better housed public (p. 8, 17).

7️⃣ How are the CJC and the prison environment positioned? The Young Consumer Consultations welcome ~32,500 young people/year (cannabis 49 %, alcohol 16 %); ~190 CSAPA operate in prisons (~22,000 people/year, 97 % men) (p. 2).

6. Rewriting in FALC (Easy to Read and Understand)

What the document says

• The CSAPA are centres that help people who have a problem with alcohol, drugs or gambling.

• In 2024, 253 centres provided their figures. This amounts to 190,066 patient records.

• In total, it is estimated that 332,600 people have visited a CSAPA.

• Most are men. The average age is 41 years.

• Many have few qualifications. Some have insecure housing. A few live on the streets.

• Alcohol is the primary reason for coming. One in two comes for alcohol.

• Next are cannabis, heroin and tobacco.

• Often, people come on their own. Family doctors refer few patients.

What has changed and what to remember

• Each product corresponds to a different profile.

• The people who come for alcohol are older and often have a job.

• The people who come for cannabis are younger. Often, it is the justice system that sends them.

• The people who come for crack or substitution treatments often live in great poverty.

• Fewer and fewer people are injecting (injections are decreasing).

• For cannabis, there are new edible forms, like candies.

Words explained: CSAPA = centre that helps with addictions. TAO = substitution therapy (medication given instead of drugs). Active file = total number of people followed in the year.

7. Cross-sectional analysis — values of Health Practices

Framing note: this is a statistical report intended for decision-makers and professionals, not a participatory intervention tool. Several values are therefore not addressed by the document — this is honestly noted (assumed template misalignment).

Literacy : not addressed. Dense report for professionals, without a simplified version or adaptation to levels of understanding.

Empowerment : absent. People are described as statistical objects; no user voice or involvement in the analysis.

Participation : no co-construction described; RECAP is filled in by the structures.

Community health: present in a subtle way (outreach, marginalised groups, urban/rural inequalities, p. 3), without being the focus of the document.

Ethics : the methodological limits are explained (declarative, threshold 10 %, ~20 % non-response); no analysis of cultural biases.

Human rights: equity of access is addressed through territorial inequalities and marginalised groups (p. 3), without a formalised 'rights' framework.

Intersectorality : health, social, judicial and community medicine partnerships mentioned throughout the orientation motives, without a dedicated recommendation.

Partnership : no formalised collaboration model — descriptive document.

Fight against discrimination: the social gaps by product are documented; stigmatisation is not thematised, but the data can be used to objectify it.

8. Assessment of the reliability of the resource

Scientific relevance — high. Reference institutional source (OFDT), methodology explained and assumed limits (threshold 10 %, rounding rules, comparison to constant field), sourced bibliography, 2024 data very recent. Reservations to keep in mind: declarative collection, total active file dated 2022, ~20 % of records without product, participation rate of 51 %.

Operational relevance — indirect but real. This is not a practice guide: it is a diagnostic and argumentation tool. Directly useful for situating its active file, advocating for resources and targeting outreach; to be complemented by practice guides to take action (see external references).

9. Strategic hashtags

#healthpractices #Addictions #CSAPA #RiskReduction #OFDT #PublicHealth #PrecarityAndHealth #Outreach

This article was developed in accordance with the Charter of the use of artificial intelligence of Health Practices. Click on the image